There is no doubt that the recent Supreme Court decision to uphold key aspects Affordable Care Act (ACA), and to thereby preserve the expansion of health coverage to millions of Americans is momentous. That said, the health care system reformed by the ACA still leaves millions uninsured or underinsured, and maintains the strangle hold on health care by the insurance and pharmaceutical industries. In spite of the ACA, health care will remain largely unaffordable to many due to co-pays, deductibles, and frequent gaps in coverage. The rising cost of certain drugs is forcing patients into more debt, or to forego necessary medicine. [1] Further, patients with high deductible insurance plans may be pressured to skip care of common conditions such as heart failure, coronary artery disease, diabetes, hypertension among others. [2] It is our belief that only universal health coverage can assure affordable health care for all.

nancy pelosi speaks regarding the affordable care act

Credit: Flickr / Nancy Pelosi

However, while universal health care is a sine qua non for change, it is not sufficient for the transformational creation of a healthcare system that truly provides compassionate care for patients and meaningful work for caregivers. While the ACA and many single payer plans do include quality improvement aspects, these are mostly metric based measures, and best practice guidelines – they do not fundamentally challenge the culture in which health care is delivered. Further, many of these quality improvement requirements, because they have not been well thought out, have associated unintended consequences to the detriment of patient care. A vision of what a transformed health care delivery system would be would include:

  • The empowerment of health care workers to articulate changes in health care delivery. This would challenge the “top down” management style of current healthcare organizations, which often ignores the creativity and desire for improvement on the part of front line health care workers. This would also address the current low morale in health care workplaces where many, including physicians, feel devalued, disrespected, and ignored. Such low morale leads inevitably to poor patient care.
  • Progressive and enlightened healthcare executive leadership to provide resources necessary to re-engage healthcare workers in the mission to provide quality care.
  • The creation of health care teams comprised of, in addition to physicians, nurses, physical therapists, nutritionists, pharmacists, psychologists, and spiritual guides. Such teams prevent the reduction of a patient to a disease process, reduce the possibility of medical errors, and assure that care is coordinated and well understood by all caregivers as well as by the patients themselves.
  • A healing of the division between traditional Western medical (allopathic) approaches, and alternative (homeopathic) approaches to healthcare.
  • Attention to the coordination of care transitions, from hospital care to ambulatory care, from hospital to long term care facilities, so that high quality care is continuous.
  • Attention to the quality of care of an expanding aging population, with attention to the quality of life as personal independence declines, and promoting an end of life care that maintains dignity and comfort.
  • Changes in medical and nursing education that are consistent with a new way of thinking about health care delivery, and that ends an educational process that has become exploitative in its burden of hours worked and volumes of patients seen, a process that leads to errors and poor care. Young doctors and nurses should see themselves and each other as members of a health care TEAM, which works to provide care that is truly patient centered, and is fulfilling to its providers.
  • Making connections between healthcare and the quality of peoples’ lives and their environments in their communities, their countries, and globally.
  • Attention to the psychological stresses and strains of the current health care delivery system. Currently this is acknowledged only after the fact of chemical dependency, mental illness and suicide among health care providers. We need a more pro-active approach that provides a work process that allows time for rest, relaxation, attention to personal issues,  and that promotes a work process that can be enjoyable and fulfilling.
  • Urgent attention to additional areas of healthcare, currently neglected:
    • Mental health issues – integrating behavioral health into the care model, and requiring a more complex and comprehensive concept of the mind/body continuum
    • Quality and safety in healthcare for prisoners
    • Military and veterans’ health
    • The culture of gun violence
    • Global and environmental health. This country can no longer assume isolation from epidemics and mass hunger ravaging other parts of the world. The world today is truly a global village, of which we are a part. Attention to the world population and the environment is critical for the health of the planet and all who live on this earth.

While the ACA may be a first step, and universal health care coverage a necessity, it is our belief that neither, by itself, will lead to the kind of transformation necessary for our healthcare system. The transformative vision of healthcare that we propose will require the action and activism of healthcare providers, and the American public, in demanding that health care be not only accessible, but also compassionate, comprehensive, and delivered by men and women who are inspired by their work.


[1] Washington Post, July 1

[2] Modern Healthcare, July 1

Martha Sonnenberg, M.D. is a former Chief Medical Officer, a specialist in Infectious Diseases, and is currently a consultant in issues of hospital quality and safety.


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